NURS 611 Exam 4 Advanced Pathophysiology Review: Renal, GI, Pulmonary, Endocrine, Reproductive,
and Hematology – 150 Practice Questions with Multiple Correct Answers, Rationales, and Evidence-
Based Updates.*
Renal & Urinary System (1–25) – Version 2
1. Which findings are characteristic of acute tubular necrosis (ATN) from ischemia? (Select all that
apply)
A) Muddy brown granular casts
B) Fractional excretion of sodium (FENa) >2%
C) Urine osmolality <350 mOsm/kg
D) Rapid onset of oliguria
E) FENa <1%
Correct Answers: A, B, C, D
Explanation: Ischemic ATN shows muddy brown casts, FENa >2%, low urine osmolality (<350), and
acute oliguria. FENa <1% suggests prerenal azotemia.
2. Which are risk factors for struvite kidney stones? (Select all that apply)
A) Chronic urinary tract infection with Proteus mirabilis
B) Alkaline urine pH >7.2
C) Hypercalciuria
D) Urease-producing bacteria
E) Low urine citrate
Correct Answers: A, B, D
Explanation: Struvite stones (magnesium ammonium phosphate) form with urease-producing bacteria
(Proteus, Klebsiella) and alkaline urine. Hypercalciuria and low citrate cause calcium stones.
3. Which clinical findings suggest renal vein thrombosis? (Select all that apply)
A) Acute flank pain
B) Gross hematuria
C) Sudden worsening of proteinuria
D) Nephrotic syndrome (especially membranous nephropathy)
E) Polyuria
Correct Answers: A, B, C, D
Explanation: Renal vein thrombosis presents with flank pain, hematuria, worsening proteinuria, and is a
complication of nephrotic syndrome. Polyuria is not typical.
4. Which are indications for renal biopsy? (Select all that apply)
A) Unexplained acute kidney injury with normal-sized kidneys
B) Nephrotic syndrome in an adult
C) RPGN (rapidly progressive glomerulonephritis)
,D) Isolated microscopic hematuria with no proteinuria
E) Suspected renal vasculitis
Correct Answers: A, B, C, E
Explanation: Biopsy indicated for unexplained AKI, adult nephrotic syndrome, RPGN, vasculitis.
Isolated hematuria without proteinuria usually does not require biopsy.
5. Which electrolyte disturbances occur in tumor lysis syndrome? (Select all that apply)
A) Hyperuricemia
B) Hyperkalemia
C) Hyperphosphatemia
D) Hypocalcemia (due to hyperphosphatemia)
E) Hypermagnesemia
Correct Answers: A, B, C, D
Explanation: Tumor lysis: hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary
hypocalcemia (calcium phosphate precipitation). Hypermagnesemia is not typical.
6. Which are causes of hyporeninemic hypoaldosteronism (type 4 RTA)? (Select all that apply)
A) Diabetes mellitus
B) Chronic interstitial nephritis
C) NSAID use
D) Obstructive uropathy
E) Sickle cell nephropathy
Correct Answers: A, B, C, D, E
Explanation: Type 4 RTA (hyperkalemic, normal anion gap acidosis) occurs in diabetes, interstitial
nephritis, NSAIDs, obstruction, sickle cell, and HIV.
7. Which medications are used to treat hyperkalemia in renal failure? (Select all that apply)
A) Calcium gluconate (cardioprotection)
B) Insulin + glucose (shifts K+ into cells)
C) Albuterol nebulizer
D) Sodium polystyrene sulfonate (Kayexalate)
E) Loop diuretics (if urine output present)
Correct Answers: A, B, C, D, E
Explanation: Hyperkalemia management: calcium (membrane stabilization), insulin/glucose, albuterol
(beta-2 shift), kayexalate (gut binding), loop diuretics (excretion), dialysis (severe).
8. Which are findings in malignant hypertension (hypertensive emergency with renal involvement)?
(Select all that apply)
A) Hypertensive retinopathy (cotton wool spots, hemorrhages)
B) Microangiopathic hemolytic anemia (schistocytes)
C) Thrombocytopenia
D) Acute kidney injury with proteinuria
E) Hyperreninemia
,Correct Answers: A, B, C, D, E
Explanation: Malignant hypertension causes arteriolar fibrinoid necrosis, leading to retinopathy, MAHA
(schistocytes), thrombocytopenia (microangiopathic), AKI, and high renin.
9. Which are causes of acute poststreptococcal glomerulonephritis (APSGN)? (Select all that apply)
A) Group A beta-hemolytic streptococcus pharyngitis
B) Skin infection (impetigo) caused by nephritogenic strains
C) Post-streptococcal arthritis
D) Positive anti-DNase B or ASO titers
E) Low C3 complement levels
Correct Answers: A, B, D, E
Explanation: APSGN follows pharyngitis or skin infection with nephritogenic strains (e.g., M types 1,
12). Low C3 (due to immune complex consumption) is hallmark.
10. Which findings suggest Goodpasture syndrome (anti-GBM disease)? (Select all that apply)
A) Linear IgG deposits on renal biopsy
B) Rapidly progressive glomerulonephritis (RPGN)
C) Pulmonary hemorrhage (hemoptysis, diffuse alveolar hemorrhage)
D) Positive anti-GBM antibodies
E) Low C3 complement
Correct Answers: A, B, C, D
Explanation: Goodpasture: anti-GBM antibodies, linear IgG on biopsy, RPGN, pulmonary hemorrhage.
C3 is normal (unlike lupus or post-strep).
11. Which are causes of Fanconi syndrome (proximal tubular dysfunction)? (Select all that apply)
A) Multiple myeloma (light chain toxicity)
B) Wilson's disease
C) Cystinosis
D) Tenofovir or ifosfamide
E) Lead poisoning
Correct Answers: A, B, C, D, E
Explanation: Fanconi syndrome: impaired proximal tubule reabsorption (glucosuria, phosphaturia,
aminoaciduria, proximal RTA). Causes: myeloma, Wilson's, cystinosis, drugs, heavy metals.
12. Which are findings in renal artery stenosis from atherosclerosis? (Select all that apply)
A) Older age and smoking history
B) Bruit heard over renal artery (epigastric or flank)
C) Flash pulmonary edema (sudden volume overload)
D) Worsening renal function after ACE inhibitor
E) Unilateral small kidney on ultrasound
Correct Answers: A, B, C, D, E
Explanation: Atherosclerotic RAS: older, smoker, bruit, flash pulmonary edema, ACEi-induced AKI,
asymmetrical kidney size.
, 13. Which are causes of nephrolithiasis associated with hypercalciuria? (Select all that apply)
A) Primary hyperparathyroidism
B) Idiopathic hypercalciuria
C) Sarcoidosis (hypercalcemia from 1,25-OH D)
D) Distal renal tubular acidosis (type 1)
E) Low urinary citrate
Correct Answers: A, B, C, D, E
Explanation: Hypercalciuria causes calcium stones: hyperparathyroidism, idiopathic, sarcoidosis, RTA
type 1 (also high urine pH). Low citrate worsens stones.
14. Which are complications of chronic kidney disease (CKD) mineral bone disorder? (Select all that
apply)
A) Hyperphosphatemia
B) Hypocalcemia
C) Elevated PTH (secondary hyperparathyroidism)
D) Vitamin D deficiency (low 1,25-OH D)
E) Osteitis fibrosa cystica (bone resorption)
Correct Answers: A, B, C, D, E
Explanation: CKD-MBD: phosphate retention → low calcium → high PTH → bone disease (osteitis
fibrosa), low vitamin D (loss of 1-alpha-hydroxylase).
15. Which drugs require dose adjustment in CKD? (Select all that apply)
A) Metformin (risk of lactic acidosis)
B) Gabapentin (neurotoxicity)
C) Digoxin (toxicity)
D) Apixaban (DOAC)
E) Acetaminophen
Correct Answers: A, B, C, D
Explanation: Metformin, gabapentin, digoxin, DOACs need dose adjustment in CKD. Acetaminophen is
safe but avoid chronic high doses.
16. Which are causes of acute pyelonephritis? (Select all that apply)
A) Vesicoureteral reflux
B) Urinary obstruction (stone, BPH)
C) Indwelling urinary catheter
D) Pregnancy
E) Diabetes mellitus
Correct Answers: A, B, C, D, E
Explanation: Risk factors for pyelonephritis: reflux, obstruction, catheter, pregnancy (physiologic
hydronephrosis), diabetes (neurogenic bladder, immunocompromise).
17. Which urinalysis findings are typical of acute interstitial nephritis (AIN)? (Select all that apply)
A) White blood cell casts
B) Eosinophiluria (Hansel's stain)
and Hematology – 150 Practice Questions with Multiple Correct Answers, Rationales, and Evidence-
Based Updates.*
Renal & Urinary System (1–25) – Version 2
1. Which findings are characteristic of acute tubular necrosis (ATN) from ischemia? (Select all that
apply)
A) Muddy brown granular casts
B) Fractional excretion of sodium (FENa) >2%
C) Urine osmolality <350 mOsm/kg
D) Rapid onset of oliguria
E) FENa <1%
Correct Answers: A, B, C, D
Explanation: Ischemic ATN shows muddy brown casts, FENa >2%, low urine osmolality (<350), and
acute oliguria. FENa <1% suggests prerenal azotemia.
2. Which are risk factors for struvite kidney stones? (Select all that apply)
A) Chronic urinary tract infection with Proteus mirabilis
B) Alkaline urine pH >7.2
C) Hypercalciuria
D) Urease-producing bacteria
E) Low urine citrate
Correct Answers: A, B, D
Explanation: Struvite stones (magnesium ammonium phosphate) form with urease-producing bacteria
(Proteus, Klebsiella) and alkaline urine. Hypercalciuria and low citrate cause calcium stones.
3. Which clinical findings suggest renal vein thrombosis? (Select all that apply)
A) Acute flank pain
B) Gross hematuria
C) Sudden worsening of proteinuria
D) Nephrotic syndrome (especially membranous nephropathy)
E) Polyuria
Correct Answers: A, B, C, D
Explanation: Renal vein thrombosis presents with flank pain, hematuria, worsening proteinuria, and is a
complication of nephrotic syndrome. Polyuria is not typical.
4. Which are indications for renal biopsy? (Select all that apply)
A) Unexplained acute kidney injury with normal-sized kidneys
B) Nephrotic syndrome in an adult
C) RPGN (rapidly progressive glomerulonephritis)
,D) Isolated microscopic hematuria with no proteinuria
E) Suspected renal vasculitis
Correct Answers: A, B, C, E
Explanation: Biopsy indicated for unexplained AKI, adult nephrotic syndrome, RPGN, vasculitis.
Isolated hematuria without proteinuria usually does not require biopsy.
5. Which electrolyte disturbances occur in tumor lysis syndrome? (Select all that apply)
A) Hyperuricemia
B) Hyperkalemia
C) Hyperphosphatemia
D) Hypocalcemia (due to hyperphosphatemia)
E) Hypermagnesemia
Correct Answers: A, B, C, D
Explanation: Tumor lysis: hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary
hypocalcemia (calcium phosphate precipitation). Hypermagnesemia is not typical.
6. Which are causes of hyporeninemic hypoaldosteronism (type 4 RTA)? (Select all that apply)
A) Diabetes mellitus
B) Chronic interstitial nephritis
C) NSAID use
D) Obstructive uropathy
E) Sickle cell nephropathy
Correct Answers: A, B, C, D, E
Explanation: Type 4 RTA (hyperkalemic, normal anion gap acidosis) occurs in diabetes, interstitial
nephritis, NSAIDs, obstruction, sickle cell, and HIV.
7. Which medications are used to treat hyperkalemia in renal failure? (Select all that apply)
A) Calcium gluconate (cardioprotection)
B) Insulin + glucose (shifts K+ into cells)
C) Albuterol nebulizer
D) Sodium polystyrene sulfonate (Kayexalate)
E) Loop diuretics (if urine output present)
Correct Answers: A, B, C, D, E
Explanation: Hyperkalemia management: calcium (membrane stabilization), insulin/glucose, albuterol
(beta-2 shift), kayexalate (gut binding), loop diuretics (excretion), dialysis (severe).
8. Which are findings in malignant hypertension (hypertensive emergency with renal involvement)?
(Select all that apply)
A) Hypertensive retinopathy (cotton wool spots, hemorrhages)
B) Microangiopathic hemolytic anemia (schistocytes)
C) Thrombocytopenia
D) Acute kidney injury with proteinuria
E) Hyperreninemia
,Correct Answers: A, B, C, D, E
Explanation: Malignant hypertension causes arteriolar fibrinoid necrosis, leading to retinopathy, MAHA
(schistocytes), thrombocytopenia (microangiopathic), AKI, and high renin.
9. Which are causes of acute poststreptococcal glomerulonephritis (APSGN)? (Select all that apply)
A) Group A beta-hemolytic streptococcus pharyngitis
B) Skin infection (impetigo) caused by nephritogenic strains
C) Post-streptococcal arthritis
D) Positive anti-DNase B or ASO titers
E) Low C3 complement levels
Correct Answers: A, B, D, E
Explanation: APSGN follows pharyngitis or skin infection with nephritogenic strains (e.g., M types 1,
12). Low C3 (due to immune complex consumption) is hallmark.
10. Which findings suggest Goodpasture syndrome (anti-GBM disease)? (Select all that apply)
A) Linear IgG deposits on renal biopsy
B) Rapidly progressive glomerulonephritis (RPGN)
C) Pulmonary hemorrhage (hemoptysis, diffuse alveolar hemorrhage)
D) Positive anti-GBM antibodies
E) Low C3 complement
Correct Answers: A, B, C, D
Explanation: Goodpasture: anti-GBM antibodies, linear IgG on biopsy, RPGN, pulmonary hemorrhage.
C3 is normal (unlike lupus or post-strep).
11. Which are causes of Fanconi syndrome (proximal tubular dysfunction)? (Select all that apply)
A) Multiple myeloma (light chain toxicity)
B) Wilson's disease
C) Cystinosis
D) Tenofovir or ifosfamide
E) Lead poisoning
Correct Answers: A, B, C, D, E
Explanation: Fanconi syndrome: impaired proximal tubule reabsorption (glucosuria, phosphaturia,
aminoaciduria, proximal RTA). Causes: myeloma, Wilson's, cystinosis, drugs, heavy metals.
12. Which are findings in renal artery stenosis from atherosclerosis? (Select all that apply)
A) Older age and smoking history
B) Bruit heard over renal artery (epigastric or flank)
C) Flash pulmonary edema (sudden volume overload)
D) Worsening renal function after ACE inhibitor
E) Unilateral small kidney on ultrasound
Correct Answers: A, B, C, D, E
Explanation: Atherosclerotic RAS: older, smoker, bruit, flash pulmonary edema, ACEi-induced AKI,
asymmetrical kidney size.
, 13. Which are causes of nephrolithiasis associated with hypercalciuria? (Select all that apply)
A) Primary hyperparathyroidism
B) Idiopathic hypercalciuria
C) Sarcoidosis (hypercalcemia from 1,25-OH D)
D) Distal renal tubular acidosis (type 1)
E) Low urinary citrate
Correct Answers: A, B, C, D, E
Explanation: Hypercalciuria causes calcium stones: hyperparathyroidism, idiopathic, sarcoidosis, RTA
type 1 (also high urine pH). Low citrate worsens stones.
14. Which are complications of chronic kidney disease (CKD) mineral bone disorder? (Select all that
apply)
A) Hyperphosphatemia
B) Hypocalcemia
C) Elevated PTH (secondary hyperparathyroidism)
D) Vitamin D deficiency (low 1,25-OH D)
E) Osteitis fibrosa cystica (bone resorption)
Correct Answers: A, B, C, D, E
Explanation: CKD-MBD: phosphate retention → low calcium → high PTH → bone disease (osteitis
fibrosa), low vitamin D (loss of 1-alpha-hydroxylase).
15. Which drugs require dose adjustment in CKD? (Select all that apply)
A) Metformin (risk of lactic acidosis)
B) Gabapentin (neurotoxicity)
C) Digoxin (toxicity)
D) Apixaban (DOAC)
E) Acetaminophen
Correct Answers: A, B, C, D
Explanation: Metformin, gabapentin, digoxin, DOACs need dose adjustment in CKD. Acetaminophen is
safe but avoid chronic high doses.
16. Which are causes of acute pyelonephritis? (Select all that apply)
A) Vesicoureteral reflux
B) Urinary obstruction (stone, BPH)
C) Indwelling urinary catheter
D) Pregnancy
E) Diabetes mellitus
Correct Answers: A, B, C, D, E
Explanation: Risk factors for pyelonephritis: reflux, obstruction, catheter, pregnancy (physiologic
hydronephrosis), diabetes (neurogenic bladder, immunocompromise).
17. Which urinalysis findings are typical of acute interstitial nephritis (AIN)? (Select all that apply)
A) White blood cell casts
B) Eosinophiluria (Hansel's stain)
